Eating for Alzheimer's Prevention

A lzheimer's disease ravages the mind, beginning with forgetfulness and ultimately leading to impaired speech and loss of memory and bodily functions. But the scariest thing about the disease is that even with an early diagnosis, it's often too late to fix or stop the inevitable decline.

That's why geriatric neurologist Dr. Marwan Sabbagh decided to team up with Chef Beau MacMillan of Sanctuary resort in Scottsdale, Arizona, on The Alzheimer's Prevention Cookbook, a recipe book that details how the vitamins and antioxidant properties of certain foods can help protect your brain later in life.

We spoke with Dr. Sabbagh and MacMillan about the project.

Brain-Boosting Recipes from The Alzheimer's Prevention Cookbook

Dr. Marwan Sabbagh: That starts with my first book, called The Alzheimer's Answer: Reduce Your Risk and Keep Your Brain Healthy, with a foreward written by Justice Sandra Day O'Connor. In that book, I basically talk about what are modifiable and nonmodifiable risks for Alzheimer's disease, and devoted a whole chapter of the book to what you should eat and what you should not eat in your diet. And I thought it was a natural jumping-off point into a larger and deeper dive into food and Alzheimer's prevention.

Epicurious: You write in the cookbook that "once a patient has been diagnosed, we're more or less unable to reverse the ravages to the brain." Is that why prevention is so important?

MS: I'm a geriatric neurologist that specializes in the care and treatment of people with Alzheimer's and other kinds of dementia, and if you really look at the growing body of evidence, it is very, very clear that there's two striking and unsettling facts: One is that the changes in the brain that [lead] ultimately to the dementia as you and I know it, start 20, 25 years before the first onset of symptoms. The second thing we're starting to see is that treatment of Alzheimer's is becoming a much tougher nut—pardon the metaphor—to crack than we thought. The outcomes are not as robust as we had hoped. So myself and many others are moving toward a more critical eye on prevention. But the obvious thing to consider is that the easiest thing that can be modified…is…diet…, and so that's why I really wanted to emphasize that. I tell everybody my goal in life is to work myself out of a job. If a thousand people read this book and it prevented Alzheimer's in five of them, that's still a huge step forward than where we are now. It does illustrate a need to focus on diet as part of the overall prevention strategy.

Epicurious: Can diet prevent the disease?

MS: The 20,000-foot view of course is that we would love to ideally say you can prevent your Alzheimer's just by eating a healthy diet. I think it clearly can be a benefit, and I'm sure it can reduce risk. Can it offset your genetic propensity? I cannot guarantee that. But there has been in the medical literature consistent bodies of evidence—particularly population-based studies—around fish-based diets, Mediterranean-based diets, Indian food, certain spices. It was easy to start building the story around those consistent themes, because they've been published regularly. And then I wanted to take that one step further and say, "OK, this is what you should eat and why," and here's what the science suggests to support that point of view. I didn't just want to say, "Eat this because it feels good and it's the right thing to do." I wanted to give you the specific mechanism as to why that would make a difference.

Epicurious: So what are some of the particular ingredients that have been shown to help brain health?

MS: The first thing we need to appreciate is that we want to reduce the amount of saturated fat in our diets. The amount of saturated fat in the American diet has really gone up, and if you look up at the consumption of omega-6 versus omega-3, 100 years ago it was like 4:1, and now it's 30:1. One of the things we can do, of course, in addition to eating more omega-3s, we can reduce the amount of saturated fat. Omega-6 and omega-9 in our diet, that's one thing.

When you kind of look at the themes of something like a Mediterranean diet, it really coalesces around the idea that you're having less saturated fat, more fish consumption, and more whole grains and legumes. So the themes that show up are consistent in terms of more anti-inflammatory consumptions and less saturated fat in general, and then of course, vitamin-rich and antioxidant-rich foods as well. We would go with those kind of in the mix. I wouldn't say, "Oh, just eat antioxidants." I think you need to be broader than just eating antioxidants and flavonoids and things like that; you've really got to take this in multiple approaches, I would say.

Epicurious: And it's important to eat vitamins like B rather than take them in supplement form?

MS: Correct. I tackled that early in the discussion as to vitamins versus supplements. People want to eat their Big Mac and take their vitamin, thinking that it's going to offset their risk. But in reality that's not the case. You cannot just take a supplement to offset your risk. You must consume the nutrients in your diet, both improving the positive nutrients and reducing the negative nutrients.

Epicurious: Chef MacMillan, did Dr. Sabbagh give you a list of ingredients to work with as you developed the recipes?

Chef Beau MacMillan: The first question out of my mouth in collaborating with him was, "Look, I know how to cook healthy cuisine, I'm not sure I know how to cook brain-healthy cuisine. What does that entail?" Marwan sent me the first two chapters of the manuscript, and with that he was so helpful, because he's so smart in regards to the science side, the book's ingredient-driven anyways. He talks so much about anti-inflammation ingredients and incredibly healthy ingredients—things that are out there like kale. So I had this amazing canvas, this amazing template, that I knew I could impart turmeric here, I could impart cinnamon here, I could do kale here, beets, açia berry.

MS: Beau created this brain-boosting broth, kind of coined it on his own. I thought that was just a stroke of genius on his part. That's woven into many of the recipes he's created. That captures a lot of nutrients in one fell swoop.

BM: Ultimately, we wanted to create a beautiful vegetable stock where we could compile some of the most common ingredients that are the best for you and include a foundation to go anywhere (without a great stock, you can't have a great soup). Chefs will use rich duck stocks or chicken stocks. I remember cooking this down and going through the trial of the recipe and adding more. It was rich, it had incredible fennel flavor and vegetable flavor, and just good properties. The broth alone, if you want to drink a cup of the broth as a tea or after a Pilates class, I was happy with that.

Epicurious: Dr. Sabbagh, are there certain foods with greater brain-protecting properties than others?

MS: I say the answer is probably yes. We like coining the term "superfoods" because they're considered kind of endowed with greater amounts of antioxidants, of free-radical-scavenging potential. What we do know consistently in the superfood realm is the polyphenol-rich foods like the berries and pomegranate probably are consistently good for you, but here we get into the translation—what they have shown is that people who eat antioxidant-rich foods have reduced risks, but they don't always get into the deep dive of trying to extract which specific ones. In the book, what I'm trying to do is extrapolate on the basis of what they recommend for polyphenol-rich or flavonoid-rich foods, so berries would be a good one to go after, and I think pomegranate would be too on the fruit side, and clearly the high-antioxidant-rich foods like kale on the vegetable side.

Epicurious: Chef MacMillan, as a side effect of working on the project, you lost weight, didn't you?

BM: I've been a chef my whole life, and I've struggled in health as a chef with eating. I've weighed 210 pounds and played hockey twice a week, and I've weighed 330 pounds and ate cheeseburgers and drank beer on my night off. So it's kind of a gut check; when he approached me and said, "Hey, look, we're doing a brain healthy cookbook," I thought to myself, "Man, so you want to partner with me? A guy who physically doesn't look healthy or isn't healthy," and I took a lot of stock in that and said to myself, "Man, this is an opportunity, give this a chance." It's funny, because it's changed my outlook, and I've lost a total of 70 pounds. It's affecting me just with the consciousness of clean eating, healthy cuisine. I'm not trying to say, "Oh, it's a weight-loss book," because that's not what it was designed to do. The more information you have, the more powerful it is, in how you can understand it or even be in the conscious moment of it, because I think we get lost in food sometimes.

Epicurious: Dr. Sabbagh, is there anything else a reader of the book should know about eating for brain health?

MS: I just hope people will enjoy the process and take it to heart, and realize that they can empower themselves to make meaningful and substantive changes in their life that could have a very positive impact on their future.